Latest / The Uncommons / 3 Doctors Told Him He Needed Spinal Fusion. He Refused | Ep 28
Transcript
- Parisa Bady: If you ever sat disappointed in a doctor's office because you were told this is your only option, this episode is for you. Years ago, Paige was dealing with severe back problems. He saw multiple doctors, and the answer kept coming back: spinal fusion surgery. He refused to do the surgery, and instead, he chose a different path through regenerative medicine. And what happened next didn't just change his back, it changed the way he saw medicine. And through that, he changed thousands of patients' lives. What makes this conversation especially interesting is because Paige has been practicing medicine for 33 years, but he's been in and out of Western medicine. He went to India to study Ayurvic medicine, he opened a cannabis company to help patients with pain, and he eventually found himself in regenerative medicine. So today we're asking, where should you trust the Western medicine and where you should question it? By the end of this episode, I want to have an exact framework of thinking about that question. Without assuming conventional medicine is always bad or alternative medicine is always the answer. And the most important question of all, how do you know when you're advocating for yourself and when you're just refusing the answer you didn't like? Hi, welcome to the On Comments Podcast, where we discuss what it really takes to have a meaningful life. I'm Parissa. Paige. We're going to talk about you today, sir. Yay! Another surprise. Another surprise. So you had a severe back problem. You could not walk to your car to go to work. You remember that? I remember that. You could not get out of bed without pain. It was just brutal. And you were told by your own brother, who's a spinal surgeon, and a bunch of other people who are your friends, that you need to do an emergency spinal fusion surgery. And you refused. Yes, something like that. Can you please go through it and the decision making process of it? This time I feel like I'm I'm actually being interviewed, like I'm usually being interviewed. I a lot of interviews, so I'm I'm very comfortable here as opposed to a regular podcast and we talk about medicine, which I love. It's my passion in life. Yeah, and I've dedicated thirty-three years of my life being a physician. I come from generations of doctors, I think eighteen to be exact. Wow. I'm not sure f how accurate that is, but we're Persians and Iranians were spearheading science and mathematics and physics throughout history and we've been part of that lineage for twenty five hundred years. And my dad's a doctor, all my uncles are doctors, and you know, when he came into our family, yeah, almost all my cousins are doctors. all the conversations at dinners are interesting. I could not swallow one bite of food the first few months 'cause they were all talking about this patient and that patient and what was in their tummy and what was in their butt and in their head and I'm like, my god. Yeah, so my spine is ha had major problems. I had a ski accident right in the middle of COVID. Because he didn't listen to his wife. And anyhow, and blew out my knee, a second time blown out my knee. We had a major reconstructive knee surgery. And I was told by my our friend, our doctor who did the surgery, he's like, listen, this skiing thing, you know, you won't be able to get it on for another three years. I'm like, I'll be on the same mountain less than twelve months. So I started working out really, really hard and I hurt my back. Deadlifts. I was doing deadlifts. Get away from deadlifts. Over a week's time, maybe maybe less than a week, maybe four or five days, first I started having Pain and numbness down my leg. Then I have a foot drop, which means that your nerve is impinged, which becomes almost an emergent surgery. And I basically could not lift my foot and I was dragging my leg. And the pain got so severe. Obviously I couldn't work. I couldn't walk. Couldn't drive. You were my driver, which is kind of cool. I had my own driver, free driver all the time. But my brother's an orthopedic spine surgeon and you know I manage large healthcare companies. I know everybody and everybody said either a three-level fusion or two-level fusion with one artificial disc or one level fusion with two artificial discs, that would have a significant failure rate. We're talking about ten or fifteen percent failure rate. And when these discs collapse and fail, it's a disaster. Any one of those surgeries required them to open me up. Take all of my organs out and go in and get a vascular surgeon to put my vessels apart to be able to reach the spine from the front, put a cage or the screws and metals and all that kind of stuff, then close me back up and then flip me over and go to the other side from the back. So just the organs and vessels movement would give me so much scar tissue and I knew my life is gonna be over. Like I had young kids. I started over but And for someone at your level of activity. Yeah, skiing, tennis, and you know, all kinds of stuff. Rotational sports. That's just like so it was a death sentence to me, to me, to be honest with you. Like I don't care what people say, when somebody says you're unable to do any rotational sports, you're not gonna be able to lift your kids, and your rotation or range of movement drops by 70% or 60%. I've been doing this all my life. I know what that means. So at that time I I just refused. And luckily at the time, we owned our own stem cell company, which we started years ago. We're one of the pioneers of it. Just like some of the other stuff I got into Ayurvedic medicine, cannabis and so forth. This was the upcoming thing about ten years ago, ten, eleven years ago, twelve years ago actually, with Tiger Woods. I started studying it and I just love new emerging medicine. And I knew and I felt that this is going to be something life changing and it has been. So I went to my partner who's a Harvard guy, does all of our spines for the regenerative side. I became partners with him because I've never seen anybody place needles like this guy ever. And we said, look, we're going to do the biggest spine stem cell procedure from my own bone marrow. What you mean by bone marrow is that they would collect the stem cell from your own bone marrow. One of the reasons I got into this, by the way, is because the healing effects of our own body, I've seen it with Ayurvedic medicine. I've seen it with the endocannabinoid system, with cannabis. Like all hydrocarbon, natural, non-synthetic, no metals, no hardware. And our own bone marrow, I believe, is still the best. There's we use umbilical cord and stuff like that as well. We've been using it for for a long time. But this is what I chose for me with my partner. And we did the biggest stem cell procedure on me five years and two months ago. And I play tennis four times a week. skiing. How long after the stem cell procedure in your spine did you start playing tennis and skiing again? About a year. The self healing process of the stem cell takes a while. Obviously. It has to be done right. It has to be i in a proper operating room under live CT and it has to be the right surgeon doing it. So let me ask you that, because I had neck pain for the longest time. And I saw an ad for stem cell. This is years ago. And I went to this clinic. They were like, if you have neck problem, if you have a spine problem, come in and stem cell can help you. I'm like, okay. So I went in. It was in a in a chiropractor clinic. So I lay down on a chiropractor table. And he looked at my spine, no MRI, no X-ray, and he said, Yeah, stem cell can help you. And I said, Well, how do you do it? He's like, I mean, we just get a stem cell from an umbilical cord and we inject in your neck. And I'm like, How do you like do you where do you do it? He's like, right here on the chiropractor table. And I'm like, how do you know where the stem cell goes? He's like, no, don't worry, we just put the stem cells in and the stem cells will find their way to the problem area and they'll fix it. And I'm like, okay, no, thank you. You're not gonna inject my neck on a chiropractor table. So I left. I mean, I know the level of sophistication that you guys do it, but there's a lot of things out there because it's a new medicine and emerging. If somebody is in the same boat, they have a back problem, they've been having issues, they've been told they need to do spinal fusion or spine surgery, and they really don't want to undergo that level of operation. How would they know, first of all, if stem cell can help them? And how would they know how to pick the right place to get stem cell therapy? So if if I told you how many times I hear this story in our office, it's incredible. So the answer to your question is pretty simple. There is obviously I don't want to badmouth anybody, but there's a lot of these things out there. And there's a lot of patients that come to us and after surgery and they're like, well, I'll be searched and We just didn't know what to do because none of these people seemed credible. And we just did the surgery. First of all, a chiropractor cannot hold a needle in their hand. I mean they can hold it, but they can never penetrate the the t any tissue. They're not allowed. It's illegal. So besides the legalities or pro professionalism, there's few things that you could do. I believe that all healthcare businesses should be owned by physicians because physicians make the right decision for the patient and Hopefully most of them are not financially driven. They're patient outcome driven. One. Two, the operating physician needs to be a board certified fellowship trained physician in that specialty. So what kind of specialty? Pain management. We're talking about orthopedic and spine specifically. Mainly pain management, because orthopedic surgeons, like my brother, is a great orthopedic surgeon, but they cut and sew and put stuff in. Pain management people Know how to place a needle inside the right place. And that they have the highest level of training. So board certification, fellowship training is a requirement. All procedures need to be done in an operating room. We transplant this stuff under live CTX-ray, right? So we know exactly where we place these things. And the rooms need to be laminar flow, so there's airflow, there's no infection. And I would not go to any place that they don't have the option. of autologous extraction. What does that mean? We do a liposuction or bone marrow extraction. So anywhere that's reputable should be able to do any one of these modalities. So for somebody like me who is not medically educated, we have a few ways of obtaining stem cells. Yes. From umbilical cord, placenta, tissue. patient's own body which the highest concentration would be in patient's own bone marrow and patient's fat tissue. Correct. We and autologous means from patient's own body. Right. If you want to define things, we have autologous, mm-hmm meaning from auto from you, from yourself, and allogenic generated from an outside. Okay. So the outside stuff could be anywhere from exosomes. Which is not live tissue, umbilical cord, and part of umbilical cord could be the the the blood or the gelatinous material around it, which is Warren's jelly, which we like, or placenta. But it matters who it comes from, the source of a hundred percent. Like we acquire ours and we have very strict guidelines. So if anybody was going to get umbilical cords, you need to see the pedigree of where it comes from and so forth. They have to have infection controls. Not just for a whole batch, but individually for what you're getting. If you're going out there for any kind of stem cell treatment, these are the things I would look for. You gotta make sure that they have the option to do all of them. You gotta make sure that they're board certified physicians. You gotta make sure the procedure is done in an operating room and it ha it is under guidance, fluoroscopy guided, CT guided, not ultrasound. We cannot use this places that use ultrasounds for spine. That doesn't there's no way. And they need to have MRIs to see what's going on with the spine. I don't care how good you are, I've been doing this for a long time. We will not touch a patient without an MRI. Knees, joints, sometimes we do because we could see them under our live CT, but spines, there's no way. So those are the requirements that I would have for any place that I want to go to. The second layer. we go it deeper is how much research have they done? Have all of the research that has been done across the world and we have our own research project and we're in a teaching facility. So we teach other doctors on how to do this stuff and we have protocols and we have white papers that are coming out. So if somebody is looking into stem cell therapy as an alternative treatment option instead of go undergoing a really extensive surgery, what are the chances? Does it work on everybody? What are the outcomes? I know it's very dependent on who they go to and where they go, but if they go somewhere really reputable and good, not Mexico and Costa Rica, if they go into US doctors that know what they're doing, right? What should they expect as far as outcome? That's one of the things that we teach to all the doctors that we train is and it's for any kind of medicine. You have to identify the right patient for the procedure. And this is a spectrum. Right. We have so many patients that have been told, I'm bone on bone, there's nothing you could do, which is absolutely not true. eighty percent of those we could treat, but that twenty percent that that have angulation or deformities, there's nothing that stem cells could do for you. You need to have surgery. Now, the ones that we do choose, there are some that don't do well, but way higher and way better than surgical outcomes across the board. Talk about total knees. We do a lot of eighty percent of our work is knees. So what is the surgical outcome on average for knee, let's say? There's a lot of factors. We have to look at age, you have to look look at their conditions where they started, blah, blah, blah, blah, blah. But that is you're looking at close to a eight to twelve percent failure rate within the first five years of that. We have an eighty six percent response rate. To our large joints for seven years. So we haven't done the eight, nine years yet. We're getting there. but our seven years response is our 86%. Our spines, we're over 95% response rate, meaning that there is a change, but that varies. And what we call success is that if we get a patient over 50% improvement, right? 50% improvement is life changing for someone like me on a spine. For us is significant improvement. Spine issues after surgery are at seventy percent. So if somebody does surgery on their spine, they have 70% chance that an issue will come up within the next five years. Within the five years. Which that's crazy. That is crazy. Which means that when you fuse with the one level, which have you have five of these discs in between the lumbar spine, then two are fused and they become one. Now the pressure of your spine now is divided on the other ones. The ones next to it. Next to it. So if you're overweight or whatever you're doing, within a year, year and a half, the other one's gonna herniate. And that's a significant probability of that. So a lot of these patients that have a single spine d level disease end up in surgery, physical therapy, surgery, physical therapy, surgery, physical therapy for a decade. Wow. You have got your own results. yeah. And all these patients that avoid surgery. Yeah. So of course, like if I saw the result of something in front of me every day, I would be biased about it too. But it just blows my mind how many people go through surgery. I mean, I'm sure for some people it's just inevitable. They have to, right? But what would you say is a percentage of people who really don't have to do surgery. Like they could do something else instead. But they get pushed into, quote unquote pushed, not because somebody's like forcing them, but because that's the only thing is presented to them to do the surgery when they could have prevented it. I would say fifty to sixty percent. And by this I mean no offense to any doctors out there because to a hammer everything looks like a nail. Right? For me, I'm like, we want to do stem cells. Your spine surgeons don't want to do surgery. And they think, stem cells don't work. The medical doctors want to give you medicine. Being biased about this is somewhat true. But the reality of the game is that I see this every day. And it's such a new medicine that a lot of people in in medical school they don't teach us this stuff. And if you're not really open-minded, and in medical school, they teach us that you just look ahead and do what you're told. And these are your only options. And if you look left or right or up and down, you're not a real doctor. My dad told me the same thing. Like when I wanted to get into cannabis, it's like, my God, what are you got? What are you doing? my God. You know, saved my mom's life for seven and a half years, cannabis. That's why I got into it. And for stem cells, after my situation, I've dedicated my life to this thing. I've never seen in the 33 years that I've been practicing medicine. And My dad is 90. He still practices medicine two days a week. Nothing significant, but he sees sees patients. He's been practicing medicine for 65 years or 60 years or something like that. From the his historical background of what I've heard directly, I have never seen anything like this in my life. It's gotta be done right. It's gotta have all the criteria that I told you, but the outcomes are significant. So how does the stem cell very briefly, if you were to give somebody who's not medically trained a quick snippet of how stem cells work for what you do, orthopedic and spine conditions, which a lot of people have issues with it and it really changes the quality of their life. My mom included slowly without even Realizing until one day the pain is gone and until one day she can go ride a bicycle again, then she's like, Wow, I can't believe I was living like that. How does this stem cell work? How much time do I have? 30 seconds. Thirty seconds. Okay. Mesocamel stem cells have the ability to regenerate their own tissue. We get that, we extract that out from the patient's bone marrow and fat or umbilical cord or allogenic stuff. We look at these mesenchalmous stem cells, we take the highest quality ones and then we transplant them. Where we transplant them, they look like octopi. They attach. Six weeks before they attach. Once they attach under the body, they start producing and replicating the tissue that they're sitting on. So if they're sitting on cartilage in your knee or shoulder, your hip, whatever it is, they produce that material in two or three life cycles, which is about 90 days to 120 days each in the spine, in the pulpo nucleosis and and the surrounding tissue. They I'm glad I said like to somebody who's medically untrained, explain sorry, in in your disc it hydrates it and increases size, right? And regenerates new tissue. And we use PRP for the anti-inflammatory portion of it. We don't use steroids. Steroids for us is like 1980s stuff. We don't even touch it. So that's crazy because steroid really is nineteen eighties stuff, but every day people are getting steroid injection. That's a financial thing, right? Insurance companies are paying for it. The doctors are gonna do it. Patients wanna use their insurance and that's what we do. I wanna know where's the sticking point because regenerative medicine is not the only other thing out there, you know? Right. It's You mentioned cannabis, which we'll get into that for a second, which you've been in cannabis medicine industry for over a decade. Ayurvedic medicine, we talked about it before. We should go over it quickly. There are so many things. There's functional medicine now. There's like now all these new things coming out for longevity. Where is the sticking point that there are so many people still to this day that get steroid injection in their knee? Insurance companies will not pay for any of this stuff. Why why not? There's a lot of reasons why. And I I don't want to get into it today. No, get into it. Well, I sat on the other side. I I wrote contracts. you know, I was managing healthcare companies. I was on the dark side. Mm-hmm. Don't take it don't take it against me. But I learned. And that's why I left that position I was in to leave and ended up doing Ayurvedic medicine and so forth. Because I didn't want to be part of that rat race. The rat race is that. Well, let me see. If we have a hundred patients that have spine problems and we're gonna tell we're gonna cut you open, take your organs out, flip you d back and forth and all that kind of stuff, how many patients are gonna go through that procedure? I don't know. Five percent. So twenty thousand dollars. Pain medications, yeah. You know, twenty thousand, thirty thousand each, I'm out a hundred fifty thousand dollars. Stem cells are expensive. If you do it the way we right, it's not cheap. Operating rooms are not cheap. It's expensive. When insurance companies want to decide what they will cover for a patient, there is a portion of it to see how well the patient does. But money and finances come first. So they look at the utilization of this. So how many people will utilize stem cells? And what is that going to cost them? So from a hundred people. One hundred percent will use stem cells because there's no down well, I would say ninety five percent, lower risk. Yeah. No five percent will choose to get cut on under spine. Mm-hmm. They much rather pay that five patients expense because it's gonna be a hundred or hundred fifty thousand dollars. versus all that other expense that's gonna be a million dollars. So more people would opt in. For regenerative procedures because of the lower amount of risk involved and less an invasive, of course. Right. So insurances have to pay more for those procedures versus the people who actually choose to do the very invasive surgeries, then they won't have to pay as much. Right. I was on the other side. Again, I left for these reasons. It's very short-sighted. When you look at the long term effect of it, they would save a bunch of money. But they need to show their shareholders this year. How much profits they have. So they lobby against the growth of stem cells, for example, if not FDA approved. And they will if if they would make 200% back on their money, they'll be lobbying this left and right to get the FDA to approve this. So that's one aspect of it. There's many other aspects of it as well, but that's a major one. But you just mentioned that people who do, let's say, spinal fusion surgery. they would need to redo it again and again for other levels because it would get affected. Most likely. Most likely. So that's more and more cost for for the insurance companies. That's your patients who do stem cell therapy in their spine, you don't see them much again because they're good to go. Yeah, majority of our patients don't come back with the same problem. We have some that come back that we retreat or whatever we have with them. But Our success rate is business wise, it's not a really good business because you don't have you know recurrent revenue. We are starting to treat some of our patients that have been out for nine years, some at five years, some at seven, not a significant amount. The insurance companies really need to show their shareholders' profits that year, not five years. That's that's the next CEO's problem. Not this CEO's problem. So what can patients do? You know, if somebody is in a situation that they go to a conventional doctor, they get conventional options, and that's what they're told if it's not taught at medical school. Most of doctors are not gonna go and study alternative treatments on their own. Like you said, they do what they're taught, this is their vision, they're taught to cut people open, do this and that, and that's what they do. How can patients have access to all these other stuff? From Ayurvedic medicine to cannabis. The age of traditional medicine is over. The majority of doctors now are looking up stuff on Chat GPT when they want to see a patient because and I don't blame them. There's no way you can retain all the stuff that's happening around us in medicine. It's just literally impossible. So evolution of medicine is happening. I believe stem cells, the right way, is the next evolution. Of this huge growth in healthcare along with AI. We have anesthesiologists in our group for pain management and for stem cells. And anesthesia 80 years ago was a piece of stick in your mouth and a bottle of whiskey. Now you go in and they have you count in number and then you wake up and it's like the surgery's over. And you're like, you know, I've I've had it done, even for my spine, you know. And it's crazy. We do the same procedures and surgeries that we've been doing decades and decades and decades ago. I really believe this is the next evolution. Plastics guys are great because they're really open-minded, because they have to learn all the new stuff all the time. So they're really bringing in stem cells. But it's a mind shift for a physician, for the orthopedic surgeon who cuts and puts knees back together for a living, say, hey, stop doing that. Go learn all this new thing. It's financially not nearly as lucrative as what you were doing right now. And the guy's gonna say, Fuck you. Why? I think radiologists are gonna be out of business v in very short order, unless they're interventional. And interventional is gonna be out, you know, in a few years. Even our spine injections are gonna be changed to robotic injections. And I'm totally open to that. As long as you can replicate my partner's hands, which I've never seen anywhere else before. That's a very high bar, but we're open to it. Even my partner's open to it because we've seen the outcomes. Medicine is gonna change. Stem cells is the future. And AI. And AI. So, for example, our studies now used to take us six, seven people working you know, 50 hours a week to get our studies done. Now we have all of our stuff mixed, we throw it at AI systems, and I get this unbelievable profile. I mean, our patients can come in, and somebody comes in and says, I'm 72 years old, and this is my MRI. And blah, blah, blah, blah. We punch it in, we look at the thousands and thousands of patients we've treated with autologous, allogenic, whatever it is, and say, you have a 75% chance of improvement from our historical data. We were never able to do that before. It's unbelievable. We are so lucky to live in this lifetime. We will see shit that. Is explosive and life-changing. I am personally so excited about this. I'm so excited. Firstly, I'm so blessed and honored and excited that I have the chance to pick up my children and live life the way I do. Otherwise, I would have been a cripple. So I've changed my life and my entire future for stem cells. We're working with the greatest of the greatest stem cell research guy of 30 years. MD PhD from Harvard, good friend of mine. He does a lot of placenta tissue. He is very close to the biggest guys. Tony Robbins and Peter Diamantes and David Sinclair. These are the level of the guys that we're working with now, which you know, we believe that's the next level elite, the future of healthcare. And I just love it. And thank you so much for actually having me as an interviewee. It's my bandwidth. I love this stuff. I get very excited about it. So what would be the takeaway for somebody who's watching this? They are frustrated because they've been told they need to do surgery, they don't want to do surgery, or maybe they've done it and they have had not so good results with it. So they need revisions or second surgeries, third surgeries. What would you recommend them to do? Two sides to this. Any any disease, and and this is mixing my Ayurvedic background with stem cells now and also cannabis. Anything that's natural. Anything that you could do yourself is probably the best thing to do, including working out, losing weight, you know, you know, physical therapy, all that stuff, right? So don't forget about that. The patients need to know, they need to be involved. I tell my patients, stem cells are great, but if you're not willing to go to the physical therapist, I'm not gonna do the procedure. So a accountability of the patient. Secondly, look around your your options. You could always use AI. Say, this is the problem I got. What are my options? And that's a really good way. Dr. GPT. Dr. GPT. And just say list and again, I would not follow what Chat GPT or any of these guys say. I would just follow it blindly. But it allows you to have some options. Maybe Ayurvedic medicine is the right thing for you. Maybe you just need physical therapy. But I would go to people that are high end but yet have alternative approach to healthcare. If you find a really good orthopedic spine surgeon that understands the human tissue and is giving you some other options that are non-surgical, I would take that. If you go to companies that are really focused on stem cell therapy and they have their criteria we just talked about, I would do that. We, for example, do both. We do basic old school. medical healthcare and we're transitioning s to a lot of the stuff that we could do with autologous or allogenic stem cells. Right. So we fit that double criteria. But maybe acupuncture, maybe things that don't require a permanent surgical treatment that is going to leave you A with hardware because at one point they all go bad. And there's no going back. Well, no, of course not. But you know, one of the things that I talk to a lot of my joint patients, especially knee patients, is the knee arthropathy total knee replacements are good for 15, 20 years. And people are living longer and longer and longer. They probably need a revision. And even if the first one did really well, the second one is gonna be problematic because they have to go in there and break the cement, take this piece out. Replace it with something else, you know, the chances of infection things going on. And you're 80 years old at this point now. Most doctors don't want to do it at 80. From 30 some years of historical background, I've seen patients that end up on a wheelchair because their revision went bad. Otherwise, they're healthy, they have a good brain, but eventually go down aggressively because they're sitting on a wheelchair all day long. Yeah. Because they can't ambulate. And if we prolong that. If the guy's at sixty, we could do stem cells on him and prolong that to to seventy. And if you're wheelchair bound at ninety is not nearly as bad as if you if you're wheelchair bound at seventy-five. Yeah. You know, those are the things that we take into consideration, people that have had gray hair and seen some of this stuff. And certainly with spine, you know, again, my brother's a spine surgeon. We have this discussion all the time. Who refuses to get spine surgery himself, even though he has a bad back. I didn't say that. So don't leave your don't leave your health in the hands of a doctor, all respect to doctors, but somebody who sees things through one lens and one lens only. Right. Without looking as a patient as a whole with all the different things and different options that could go into this issue. Yeah, like buying a car. let me see if there's gas cars or now the new electric cars. And what is that gonna do when the gas prices are seven bucks a gallon? You know, like you have options. We didn't have that electric option 10 years ago. Yeah. We didn't have stem cells 10 years ago. Yeah. I would still go get surgery as opposed to going somewhere that is not reputable and they put some junk in your body, and they could be more damaging and problematic. Because at least the other guys are board certified orthopedic surgeons, and there should be some good coming out of it. And then if you go to someone like us, you gotta make sure that you're the right candidate for the procedure. I don't know if I would recommend stem cells on a patient like me six years ago, but now I would. Yeah. And we learn so much. Every year we become so much better. Our outcomes were 45 to 55% nine years ago. Yeah. Now we're at 86% plus because. We don't do them blind. We're in the operating room. Only you know the the right physicians are doing them. We use x-ray guidance. So we know exactly where we're going. We don't ever miss, we're cheating. Those are all options. So please look around. Be careful who you let touch your body. And look at the long term solution for your problem. And surgery can be great. Of course. But it should be the very last option. Of course. Thank you very much, Doctor.